chapter039
TRANSCRIPT
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 39
Disorders of the Male Genitourinary System
Chapter 39
Disorders of the Male Genitourinary System
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Male Reproductive AnatomyMale Reproductive Anatomy
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AndrogensAndrogens
• Testosterone
– Main testicular hormone
• Dihydrotestosterone
– Formed from testosterone in peripheral tissues
– Produced by the enzyme 5-alpha reductase
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GnRH
LH FSH Inhibin
Negative feedback
Hypothalamus
Pituitary
Interstitial cells of Leydig
Sertoli cells
SpermatogenesisTestosterone
Maturation of sperm
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Question Question
Tell whether the following statement is true or false:
Male reproductive hormones are regulated by the HPA axis.
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Answer Answer
False
The regulation of reproductive hormones is accomplished by the HPG axis (hypothalamic-pituitary-gonadal). Gonads are sex organs.
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Erection—Vasodilation Fills Spongy Tissue with BloodErection—Vasodilation Fills Spongy Tissue with Blood
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Penile DisordersPenile Disorders
• Inflammations
– Balanitis
– Balanoposthitis
– Peyronie disease
• Penile cancer
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Embryonic Development and Descent of TestesEmbryonic Development and Descent of Testes
• Testes develop from embryonic kidneys
• Descend into scrotum through inguinal canal
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Hernia Hernia
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Testicular DisordersTesticular Disorders
• Varicocele
• Hydrocele
• Testicular torsion
• Inflammations
– Epididymitis
– Orchitis
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ScenarioScenarioAn 8-year-old boy is in the emergency room. His babysitter says
the boy has a GI bug because he has been throwing up and complains of severe abdominal pain…
• When alone with you, he admits the pain is in his testes
• He presents with HR 115 bpm; RR 29 breaths/min; BP 135/95 mm Hg; pale, cold skin; no bowel sounds; severe pain in right testis; and slight swelling on the right side of the scrotum.
• His uncle recently had the mumps
Question
• What problems might this boy have? What has caused his symptoms?
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Question Question
Which testicular disorder would be the most likely to result from trauma to the scrotum?
a. Varicocele
b. Hematocele
c. Spermatocele
d. Testicular torsion
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Answer Answer
b. Hematocele
Hematocele is characterized by the accumulation of blood in the tunica vaginalis, and may be caused by scrotal trauma.
Varicoceles are varicosities in veins supporting the testes. A spermatocele is a cyst at the end of the epididymis. Testicular torsion is caused by the twisting of the spermatic cord.
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Testicular CancersTesticular Cancers
• Usually arise from germ cells
– These cells have the potential to contribute to a new body
– Therefore, they have the potential to do everything that a new body will do: multipotent
o Alpha fetoprotein
o Human chorionic gonadotropin
o Lactate dehydrogenase
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Prostate Surrounds UrethraProstate Surrounds Urethra
• Prostate enlargement compresses urethra
• Causes alterations in urination
– Weak stream
– Urgency
– Dysuria
– Discharge
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Kinds of ProstatitisKinds of Prostatitis
• Asymptomatic inflammatory
• Acute bacterial
• Chronic bacterial
• Chronic prostatitis/pelvic pain syndrome
– Inflammatory
– Noninflammatory
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Benign Prostatic Hyperplasia (BPH)Benign Prostatic Hyperplasia (BPH)
• Nodules have compressed the urethra to a narrow slit
• Decreasing testosterone levels can decrease the prostate growth
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Question Question
Which type of prostatitis is the most common?
a. Asymptomatic bacterial
b. Acute bacterial
c. Chronic bacterial
d. Pelvic pain syndrome
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Answer Answer
d. Pelvic pain syndrome
Pelvic pain syndrome (aka chronic prostatitis) is the most common prostatic syndrome. It can be inflammatory or noninflammatory, and is treated with antibiotics, anti-inflammatories, anticholinergics, or alpha-adrenergic antagonists.
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ScenarioScenario• An elderly man has problems with night urgency and joint pain.
• Blood tests show:
– Elevated plasma creatinine
– Elevated BUN
– Elevated calcium
– Prostate-specific antigen
Question
• What do you suspect is causing his symptoms?
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Childhood DisordersChildhood Disorders
• Hypospadias
• Epispadias
• Phimosis
• Paraphimosis
• Cryptorchidism